Ischemic Bowel Disease and Vasculitis
Ischemic disease and vasculitis involving small bowel fall under the category of vascular disorders of the small intestine. Because mesenteric vasculature is primarily affected in these conditions, detection of mesenteric vascular abnormality often is an
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Hee Sun Park
Contents 12.1
Ischemic Bowel Disease ..................................................................................................................
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12.2
Vasculitis ..........................................................................................................................................
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12.3
Illustration: Ischemic Bowel Disease and Vasculitis....................................................................
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References ...................................................................................................................................................
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H.S. Park Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea e-mail: [email protected] B.I. Choi (ed.), Radiology Illustrated: Gastrointestinal Tract, Radiology Illustrated, DOI 10.1007/978-3-642-55412-4_12, © Springer-Verlag Berlin Heidelberg 2015
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H.S. Park
Abbreviations
12.1.1 Acute Mesenteric Ischemia
3D CT HSP MDCT NOMI SLE SMA SMV
12.1.1.1 Acute Arterial Occlusion Acute arterial occlusion by embolism or thrombosis accounts for 60–80 % of the cases (Horton 2008). Half of the arterial occlusion is due to emboli to the superior mesenteric artery (SMA) associated with cardiac arrhythmia, valvular disease, recent myocardial infarction, or aortic mycotic aneurysm. SMA thrombosis per se which is less common and accounts for 25 % of arterial occlusion occurs in conditions of hypercoagulability or along with preexisting atherosclerosis (Kim and Ha 2003). The extent of bowel ischemia and clinical severity are dependent not only on the degree of arterial occlusion but also on the development of collateral circulation (Horton and Fishman 2001).
Three dimensional Computed tomography Henoch-Schönlein purpura Multidetector-row computed tomography Nonocclusive mesenteric ischemia Systemic lupus erythematosus Superior mesenteric artery Superior mesenteric vein
Introduction
Ischemic disease and vasculitis involving small bowel fall under the category of vascular disorders of the small intestine. Because mesenteric vasculature is primarily affected in these conditions, detection of mesenteric vascular abnormality often is an important step to diagnosis. Traditionally conventional angiography has been the confirmative tool for the detection, diagnosis, and optionally treatment of the vascular disease of the small bowel. However, with the introduction of MDCT which enabled faster scanning and thinner collimation along with detailed 3D reconstruction techniques, CT angiography can nearly perfectly reproduce the images of conventional angiography. Furthermore, CT also allows the evaluation of mural and extraluminal changes of the affected small intestine in various vascular diseases. In this chapter, ischemic small bowel diseases including acute and chronic mesenteric ischemia, which can be occlusive or nonocclusive, radiation enteritis, and vasculitis affecting mesenteric vasculature of variable vessel sizes are cov
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